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NPI Code Detail

MEDICARE: COLEMAN BUTLER FT SMITH LLC

MEDICARE: COLEMAN BUTLER FT SMITH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyAR10908AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31994117OTHERPK

General Provider Information

NPI Number : 1407844855
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLEMAN BUTLER FT SMITH LLC
Provider Business Mailing Address
First Line : 3610 GRAND AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-6842
Country : US
Telephone Number : 479-783-5171
Fax Number : 479-783-0433
Provider Business Practice Location Address
First Line : 3610 GRAND AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-6842
Country : US
Telephone Number : 479-783-5171
Fax Number : 479-783-0433
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHAEL DAVID BUTLER
Credential : PHARMD
Telephone Number : 479-783-5171
Provider Enumeration Date : 10/10/2005
Last Update Date : 03/14/2019

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1629580147 — COLEMAN BUTLER FT SMITH, LLC
Practice Location Address:
3610 GRAND AVE
FORT SMITH, AR
72904-6842
Practice Phone: 479-783-5171
Practice Fax: 479-783-0433

Directions to “COLEMAN BUTLER FT SMITH LLC ” Practice Location

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